Pseudotumor cerebri (PTC), also known as idiopathic intracranial hypertension (IIH), is a neurological condition characterized by elevated pressure around the brain. This increased pressure mimics the symptoms of a brain tumor, though no tumor is present. An ongoing discussion exists regarding a potential association between PTC and certain types of hormonal birth control.
Understanding Pseudotumor Cerebri
Pseudotumor cerebri, or idiopathic intracranial hypertension, involves an unexplained increase in the fluid pressure surrounding the brain and spinal cord. This fluid, cerebrospinal fluid (CSF), normally cushions these structures and is continuously produced and reabsorbed by the body. When CSF builds up, either due to increased production or decreased absorption, it elevates pressure within the skull. The condition is termed “pseudotumor” because its symptoms resemble those of a brain tumor, but imaging scans reveal no such growth.
Common symptoms of pseudotumor cerebri include severe headaches, which often originate behind the eyes and can worsen with activity or in the morning. Vision changes are also prevalent, such as blurred vision, double vision, temporary blindness episodes, or loss of peripheral vision. Some individuals also experience a rhythmic whooshing or thumping sound in their ears, known as pulsatile tinnitus, which matches their heartbeat. Nausea, vomiting, and neck pain can accompany these symptoms.
Diagnosis typically involves a comprehensive neurological examination, including an assessment of eye function to check for optic nerve swelling, a condition called papilledema. Brain imaging, such as an MRI or CT scan, is performed to rule out other causes of increased intracranial pressure, like tumors or blood clots. A lumbar puncture, or spinal tap, confirms the diagnosis by measuring the CSF pressure and analyzing the fluid to exclude infections or inflammation.
Pseudotumor cerebri primarily affects women of childbearing age, typically between 20 and 45 years old. There is a strong association with being overweight or obese, with a significantly higher incidence in obese women. Rapid weight gain has also been linked to an increased risk of developing the condition. While the exact cause remains unknown, this demographic pattern suggests a role for hormonal or metabolic factors.
The Connection to Birth Control
The relationship between PTC and hormonal birth control is a subject of ongoing research. Some reports and older studies suggest a potential link, particularly with certain progestin-only contraceptives and specific combined oral contraceptive formulations. Examples include products containing levonorgestrel, the injectable progestin Depo-Provera, and the etonogestrel implant Nexplanon.
Proposed mechanisms are not fully understood. Theories suggest hormonal contraceptives might influence CSF absorption or alter brain venous blood flow, leading to fluid buildup and increased pressure. Hormonal birth control can also cause weight gain, a known PTC risk factor, potentially contributing to observed correlations.
However, recent larger studies offer a nuanced perspective. Some analyses indicate no significant association between overall hormonal contraceptive use, including combined oral contraceptives, and increased PTC incidence. These findings suggest that while individual cases may appear linked, a widespread causal relationship across all hormonal birth control may not exist.
Despite these findings, the debate persists, especially for progestin-only contraceptives. Some studies acknowledge that a harmful association cannot be entirely excluded due to data limitations. PTC is rare, affecting about 2 per 100,000 people annually, though higher in obese women. This rarity makes it challenging to definitively establish or refute a direct causal link with widely used medications like birth control.
Navigating Birth Control Options with Pseudotumor Cerebri
For individuals concerned about or diagnosed with PTC, discussing birth control options with a healthcare provider is important. A medical professional can assess individual risk factors and determine the most suitable contraceptive method, considering overall health and PTC severity.
If diagnosed with PTC, healthcare providers may recommend non-hormonal birth control methods. These options do not affect hormone levels and include copper intrauterine devices (IUDs), barrier methods (condoms, diaphragms), and fertility awareness-based methods.
For some individuals with PTC, hormonal contraceptives may still be considered under careful medical supervision. Any decision to use or continue hormonal birth control should involve a thorough discussion with a doctor about potential benefits and risks, aiming to prevent pregnancy while minimizing impact on PTC symptoms.
If symptoms suggestive of PTC develop while using birth control, seek immediate medical attention. Persistent severe headaches, vision changes, or pulsatile tinnitus warrant prompt evaluation. Early diagnosis and management are important to prevent complications, including permanent vision loss. Healthcare providers can then guide on discontinuing current birth control and exploring alternatives.